SAMPLE FREEDOM OF INFORMATION ACT APPEAL LETTER
A sample FOIA appeal letter is shown below. Keep a copy of your appeal. You may need to
refer to it in further correspondence with the agency.
Principal Deputy Administrator
Centers for Medicare & Medicaid Services
Room C5-16-03
Baltimore, MD 21244-1850
Re: Freedom of Information Act Appeal
Dear :
This is an appeal under the Freedom of Information Act.
On (date), I requested documents under the Freedom of Information Act. My request was
assigned the following identification number: ____. On (date), I received a response to my
request in a letter signed by (name of official). I appeal the denial of my request.
[Optional] I enclose a copy of that response letter.
[Optional] The documents that were withheld must be disclosed under the FOIA because
(provide details you would want an agency head or appeal officer to consider when deciding
your appeal.)
[Optional] I appeal the decision to deny my request for a waiver of fees. I believe that I am
entitled to a waiver of fees. Disclosure of the documents I requested is in the public interest
because it is likely to contribute significantly to public understanding of the operations or
activities of the government and is not primarily in my commercial interest. (Provide details)
[Optional] I appeal the decision to require me to pay review costs for this request. I am not
seeking the documents for a commercial use. (Provide details)
[Optional] I appeal the decision to require me to pay search and/or review charges for this
request. I am a representative of the news media seeking information as part of news gathering
and not for commercial use.
[Optional] I appeal the decision to require me to pay search and/or review charges for this
request. I am a representative of an educational institution seeking information for a scholarly
purpose.
[Optional] I appeal the decision to require me to accept the information I seek in a paper or
hardcopy format. I requested this information, which the agency maintains in an electronic form,
in an electronic format, specifically on a personal computer disk [or a CD-ROM].
Resume Templates 1210 Document(s)
